Standing up to bad medicine

LOUISVILLE, Ky.—About a decade ago, Dr. Allan Josephson first noticed a disturbing trend of adolescents responding to trauma by trying to change their sex.

He had more than 35 years of experience in the field of child and adolescent psychiatry, but this was an emerging pattern.

“It wasn’t always there,” Josephson told WORLD News Group. “And that’s a fundamental thing to understand about this whole thing: It was virtually nonexistent 15 years ago. We didn’t see any of these kids.”

But as so-called “gender-affirming care” moved increasingly into mainstream medical practice, Josephson’s clinical approach was viewed by a growing number of hostile critics at the University of Louisville as discriminatory and “transphobic.” Ultimately, it cost him his position. Court documents, including internal emails and witness depositions, paint a picture of a university that was struggling to protect its reputation while safeguarding Josephson’s First Amendment rights and academic freedom. Josephson said the school failed to properly balance the scales, and late last month, it cost the university $1.6 million.

What the specialist saw

As chief of the University of Louisville School of Medicine’s Division of Child and Adolescent Psychiatry and Psychology, Josephson said he’d seen a lot of patients who struggled with anxiety, self-harm, and other mental health issues. For the most part, he said, these cases were the result of trauma stemming from deeper issues like divorce, sexual abuse, and real or perceived abandonment. And on the other end of the spectrum were the kids of so-called helicopter parents—immature parents Josephson said never equipped their children with the tools they needed to grow up.

“Parents who live their lives through their children, who think for their children, who control their children’s outcome,” he said. “That’s trauma of a different kind.”

Josephson believed social change and peer pressure—not medical or physical factors—were behind the growing number of adolescents identifying as transgender. And he said the problem metastasized before his eyes. Over time, Josephson said the medical community began to speak of “rapid-onset gender dysphoria,” and the number of children who claimed to be transgender spiked.

“This became a young girls phenomenon,” he said. “Mostly they would show up together, [claiming] that they all had it. I mean, if it weren’t so serious, it would be laughable.”

Josephson said he soon became unsettled by the medical establishment’s embrace of puberty blockers, hormone therapy, and even surgery to treat gender dysphoria in children. He views the treatments as drastic, permanent, and not addressing the root causes of the condition.

A vial of Testosterone Cypionate Injection Associated Press / Photo by Carolyn Kaster

“The problem is, my field has gone deeply biological, which means medications are used almost exclusively to treat children,” he said. “When we’re discussing the psychiatric treatment of children, that typically means, for many people, ‘Which pill are they going to get?’ And it’s just bad psychiatry because children don’t work that way.”

Instead, he favored a treatment that addressed the underlying trauma or lack of emotional maturity that led the adolescent to believe he or she was trapped in the wrong body. The cause could be as simple as a girl’s misguided belief that her parents would love her more if she were a boy or a boy’s perfectly understandable anxiety and confusion as puberty set in.

The presentation

Josephson told WORLD his relationship with the University of Louisville began in 2003 when the School of Medicine hired him to head up its struggling Division of Child and Adolescent Psychiatry and Psychology.

“I was recruited because people saw me as having leadership abilities to bring life to a child psychiatry division that had fallen on hard times,” he said. “By then, I had developed a national reputation in family therapy, family work, family assistance, and they wanted someone like that.”

Court documents bear out Josephson’s effort to rebuild the program over the roughly 16 years he was there. In an email contained in the court records, Dr. Charles Woods, who was at the time chairman of the School of Medicine Department of Pediatrics, said Josephson grew the division from four faculty members to a dozen, expanded its training program by 50%, and raised its profile, with division members making nearly a dozen national presentations per year. He also launched a telehealth psychiatry with a focus on rural Kentucky and greatly expanded the division’s number of emergency room consultations.

But his career nosedived in the fall of 2017 when he went to Washington, D.C., for a panel discussion hosted by the Heritage Foundation, a conservative think tank. The Oct. 11, 2017, panel was called “Gender Dysphoria in Children: Understanding the Science and Medicine” and featured Josephson alongside three other pediatric specialists. The discussion, which is still available online, focused on the panelists’ criticism of so-called gender-affirming care.

At the event, Josephson characterized transgenderism as “a sociocultural, psychological phenomenon” that medicine could not solve biologically. He said giving children who lack proper development the ability to choose their own gender constituted neglect. In lieu of medical interventions, he advocated for therapists and counselors to work with each child to identify underlying misconceptions or trauma contributing to gender dysphoria.

Josephson later said under oath at a deposition that The Heritage Foundation paid his travel and lodging expenses for the presentation. He received no compensation for the event, and no university funds went toward his appearance, he said.

The main entrance to The Heritage Foundation headquarters in Washington D.C. RoosterHD / iStock Unreleased

The fallout

Josephson’s colleagues at the medical school quickly saw the panel discussions—and they didn’t like what he said.

A couple of weeks later, a left-leaning blogger roasted the Heritage Foundation’s presentation on a now-defunct website called The Slowly Boiled Frog. In a blog post titled, “When outlets want anti-trans BS they know where to turn,” he referenced the panel and characterized Josephson as a “religious crackpot.”

Josephson told me that his belief in Biblical truth shaped the way he views gender dysphoria.

“The truth is that we were made in God’s image,” he said. “We were made men and women. We have a biological truth to the universe—and if you just try to change that, you’re going against God's law.”

The blogger didn’t agree, and his post drew the attention of Brian Buford, who was then the director of the University of Louisville LGBT Executive Center. On Oct. 25, 2017, Buford emailed the medical school dean, complaining that Josephson’s presentation was hurting the university’s national reputation: “His appearance there raised his professional profile as someone who denies transgender identity and unfortunately named the University of Louisville as his employer. I’m worried about his continued interactions with students and patients, and although I’m not an expert, I suspect he might be violating the ethical standards for psychiatry.”

He also said Josephson’s participation in the forum ran against the tenets of eQuality, a pro-LGBTQ medical school curriculum the university had recently adopted to national acclaim.

Lambda Legal

Administrators quickly began to scrutinize his activities, Josephson said. Alarm bells rang over a federal case in which he was asked to testify as an expert witness.

In 2017, Lambda Legal, a New York-based legal organization that litigates on behalf of LGBTQ causes, sued a Florida school district that barred a 16-year-old girl who identified as transgender from using the boys’ restroom. The school district asked Josephson to testify as an expert witness on its behalf. That testimony was scheduled to take place in December 2017.

In a later deposition, Josephson said his employer regularly encouraged teaching staff to testify as expert witnesses to boost the school’s prestige. He said it was considered part of an academic’s job.

But in an email dated Oct. 26, 2017, an assistant professor in Josephson’s division contacted the then-director of the LGBT Center at the University’s Health Science Center about the Florida case.

“I was contacted by a lawyer today representing this case,” the assistant professor wrote. “The lawyer indicated he is serving as the expert witness for the School in December. Yet another concern …”

The director emailed a response later that evening: “That is SO ugly. Yes, very concerning. Thanks for letting me know!”

The assistant professor said she assured the lawyer of the medical school’s commitment to gender-affirming care. She said the school followed standards of care issued by the World Professional Association for Transgender Health, or WPATH, as well as recommendations from the American Psychological Association. Within weeks Lambda Legal issued subpoenaed a dozen officials at the University of Louisville School of Medicine inquiring about the school’s teaching and curriculum regarding gender dysphoria and transgender treatment. Those subpoenas were issued in advance of Josephson’s impending expert testimony.

The assistant professor later testified in a deposition that the lawyer who contacted her about the case was Natalie Nardecchia, who at the time was a senior attorney for Lambda Legal. California Gov. Gavin Newsom has since appointed Nardecchia to serve as a Los Angeles County Superior Court judge.

Demotion

The weeks following the Oct. 11, 2017, Heritage Foundation panel were difficult, for Josephson, as was the controversy surrounding his expert testimony.

“I had people refusing to meet with me, people avoiding me in the hallways, people giving me instruction not to speak with others in public view,” he said in a later deposition. “I was banned from faculty meetings … those kinds of things, which take their emotional toll.”

Some colleagues publicly denounced Josephson’s views on caring for children with gender dysphoria. Privately, reactions were more mixed. Some colleagues quietly supported him, he told me.

“I’d have people come into my office quietly, look to the side, close the door behind them,” Josephson said. “And essentially say something like this: ’Doctor, you know, I really agree with you. I think your ideas are good, but I can’t say it publicly. I just can’t speak out.’ And they’re, of course, fearing their jobs. They’re younger people, concerned about their families and so forth.”

On Nov. 28, 2017, barely seven weeks after the Heritage presentation, Josephson was asked to resign from his role as division chief after more than 14 years of service. While sitting for a deposition by Lambda Legal in advance of his expected expert testimony, he was told to pick up a letter from Pediatrics Department Chairman Dr. Charles Woods. Woods wrote to Josephson that the majority of the faculty in Josephson’s division disagreed “with your approach to management of children and adolescents with gender dysphoria … these sentiments run deeper and broader than you have appreciated. … Unfortunately, the status quo cannot continue.”

Josephson was told to submit a letter of resignation with an effective date of Dec. 4, 2017, or face removal on that date. He sent a resignation letter the following day, on Nov. 29, 2017.

“Buckle up”

Josephson was told he would be allowed to remain as a faculty member with the division but would be required to take on more clinical responsibilities. He said the demotion came as a shock.

“The problem with my administration is no one ever talked to me,” Josephson told me. “I never had anyone sit down with me and say, ’What is going on with your teaching?’ If someone disagrees, you argue it out, you debate it, you say, ’Show me the research.’ Nobody did that.”

In his letter, Woods said Josephson’s resignation would not be announced publicly until a Dec. 4 faculty meeting. But on the afternoon of Nov. 29, the same day Josephson’s resignation letter was signed, court documents show an anonymous person using the account dr.josephson17@hotmail.com sent an email to Nardecchia at Lambda Legal, writing, “Just wanted to let you know that Dr. Josephson is resigning from his position as CEO from the Bingham clinic and as Chief of Psychiatry/Psychology effective Monday, Dec. 4th.”

The tipster was later unmasked as the then-director of the LGBT Center at the university’s Health Science Center. During a deposition, the director said she was notified of Josephson’s resignation by someone from the School of Medicine’s staff and sent the email to help Lambda Legal’s case. She created the anonymous account rather than use her own work account while worrying about getting her “hand slapped” by the school.

“I was worried that talking with an outside counsel might get me in trouble for my job,” she said, adding that she also didn’t want her identity to be revealed later in an open records request.

Whether it was intentional or not, Alliance Defending Freedom senior counsel Tyson Langhofer, who represents Josephson, said Josephson’s demotion sabotaged his planned expert testimony in the St. Johns County, Fla., School Board case.

“The case later went to a bench trial, but Dr. Josephson was never called to testify,” Langhofer said in a statement. “While we do not know the reasons the school board’s attorneys did not call Dr. Josephson to testify, it is hard to imagine the demotion was not one of them. After all, if Dr. Josephson was on the stand, the other side would likely use the resignation to undercut his qualifications and credibility as an expert.”

In December 2022, the U.S. Court of Appeals for the 11th Circuit ultimately ruled in favor of the school board, in the words of Langhofer, “vindicating the views Dr. Josephson expressed.”

Meanwhile, Josephson’s role was filled by three co-chiefs: Jennifer Le, Bryan Carter, and William Lohr. The day after Josephson’s resignation took effect, court records show Le wrote Lohr and Carter an email, in which she stated, “I think we are starting to get this bus moving in the right direction. Now we just have to make sure that everyone gets on who wants on, or gets off if that’s what they need to do as well. Buckle up?[smiley face emoji]”

Le has since been named the sole and permanent chief of the University of Louisville School of Medicine’s Division of Child and Adolescent Psychiatry and Psychology.

vgajic / E+ via Getty Images

Termination

Josephson’s relationship with the School of Medicine continued to deteriorate over the following year, court records show. In a deposition, he accused the school of creating a hazardous, humiliating work environment, effectively stripping him of his authority. He said the demotion cost him his membership in the American Association of Directors of Child and Adolescent Psychiatry. He also said he was unable to write a planned book on therapy for Oxford University Press.

The School of Medicine wasn’t happy, either. It accused Josephson of failing to complete the work output required by his new responsibilities.

In February 2019, Josephson learned that his contract would not be renewed. He sued the university in March 2019, alleging, among other things, that the school violated his First Amendment right to freedom of speech and his 14th Amendment rights to due process and equal protection under the law. His employment ended in June 2019.

Paying up

Legal proceedings dragged on for six years.

In April 2025, both sides agreed to dismiss the case. In a settlement, the school agreed to pay Josephson about $1.6 million, according to a statement from Alliance Defending Freedom.

Langhofer, an ADF senior counsel, said the settlement should serve as a stark warning to universities that, in his view, place activists instead of scientists in charge of treating minors while silencing any opposition.

“Dr. Josephson was one of the first professors to really speak out about this and actually say, ‘Hey, the recommended treatment here, I don’t think that’s helping children,’” Langhofer said. “And we saw why the others didn’t speak out because he was terminated so quickly.”

University of Louisville School of Medicine officials repeatedly cited WPATH standards of care as the basis for its philosophy on transgender treatments.

In the years following, WPATH has come under fire for what some characterize as low-quality research that is limited in scope. Last year, WORLD reported on WPATH documents leaked by the American conservationist nonprofit Environmental Progress. The documents suggested that children and adolescents who underwent medical attempts to change their sex characteristics experienced widely varying outcomes, including many who suffered and regretted the treatment. Others died as a result of the treatment, according to the leaked documents. The documents also showed that many doctors questioned whether children and adolescents had the capacity to give informed consent for such treatments.WORLD also reported in October 2024 about claims that WPATH suppressed evidence and manipulated standards in order to prioritize opportunities for WPATH members to serve as expert witnesses in U.S. court cases.

In the course of reporting this story, WORLD attempted to reach out to Jeffrey M. Bumpous, the current dean of the University of Louisville School of Medicine, for more details about the school’s side of the story. Bumpous didn’t respond. WORLD also attempted to contact Woods, and Le, who didn’t respond. WORLD was able to reach John R. Karman III, a spokesman for the university. He told WORLD the university would not comment on a personnel matter.

Josephson said he joined the Heritage Foundation panel discussion wanting to state his case academically and start a conversation. That discourse wasn’t welcomed by his employer.

“Universities are places where people disagree, debate, discuss. That’s why many of us go to work there,” he said. “But to run into a situation where if you say something that you believe to be true and we don’t like it, you’re gone, well, then it ceases to be university. It’s a death knell for academic work, and that’s what happened to me.”